LEFT-VENTRICULAR ANEURYSM COMPLICATED BY CONGESTIVE HEART-FAILURE - AN ANALYSIS OF LONG-TERM RESULTS AND RISK-FACTORS OF SURGICAL-TREATMENT

  • 1 July 1989
    • journal article
    • research article
    • Vol. 30  (4) , 648-655
Abstract
The results of surgical treatment of post-infarction left ventricular aneurysms in 49 patients with congestive heart failure preoperatively were analyzed. Average patient age was 55 years. Preoperative total ejection fraction averaged 30.5 .+-. 1.5% (mean .+-. SEM), contractile segment ejection fraction was 42.5 .+-. 1.1% and end-diastolic volume of aneurysm was 81.4 .+-. 10.4 ml. Seventy eight percent of patients underwent coronary artery bypass grafting concomitantly with aneurysmectomy. Mean follow-up after operation was 41.5 .+-. 3.5 months. Hospital mortality was 8.2%, the 5 year survival rate was 70 .+-. 7% and the 5 year complication free rate was 52 .+-. 8%. Mean functional class of dyspnea improved significantly from 2.9 .+-. 0.1 preoperatively to 1.6 .+-. 0.1 at late follow-up (p < 0.001). Likewise, isotopic ejection fraction at rest increased from 13.7 .+-. 1.3% preoperatively to 30.9 .+-. 3.0% postoperatively (p < 0.0001). Logistic regression analysis isolated two factors which influenced postoperative survival independently: contractile segment ejection fraction (p = 0.045) and myocardial score of left anterior descending coronary artery (p = 0.035). Combining these two risk factors, it was possible to identify a low risk group of patients with a 5 year survival probability of 93 .+-. 6%, contrasting with a risk group of patients having a 5 year survival of 57 .+-. 9% (p < 0.02). Thus, resection of left ventricular aneurysms complicated by congestive heart failure provides improvement in left ventricular function and clinical status. Postoperative survival is favourably influenced by an ejection fraction of the residual ventricle above 41%, associated with a graftable proximal lesion of the left anterior descending artery suitable for bypass.

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